Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Qing Zhang, Gonghua Qi, Margaux J Kanis, Ruifen Dong, Baoxia Cui, Xingsheng Yang, Beihua Kong, Qing Zhang, Gonghua Qi, Margaux J Kanis, Ruifen Dong, Baoxia Cui, Xingsheng Yang, Beihua Kong

Abstract

Objective: To compare fertility-sparing therapies including oral progestogens, hysteroscopic resection (HR), and the levonorgestrel- releasing intrauterine system (LNG-IUS) in achieving disease regression, recurrence and live birth rate in well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia(CAH).

Study design: This was a meta-analysis of previous studies focus on the fertility-sparing therapy for well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia (CAH).

Date sources: Medline, the Cochrane Library and Embase was searched with the terms and Synonyms: words similar to eEC and CAH with therapies associated with fertility-sparing.

Main outcome measures: The number of all patients accepted fertility sparing therapies, patients got regressed, relapsed and delivered were extracted from each study, and the regression, recurrence, and live birth rate of each study were calculated. The regression, recurrence and live birth rates between each two interventions were compared with the aid of meta-regression in packages of "meta" and "meta for" written in R.

Results: Fifty-four studies reported fertility sparing therapies in young women with eEC and CAH were included. Meta-analysis showed that HR followed by progestogens achieved a higher pooled regression (98.06% vs 77.20% P < 0.0001) and live birth rate (52.57% vs 33.38%, P = 0.0944) and a lower recurrence rate compared with oral progestogens alone (4.79% vs 32.17% P = 0.0004). At the same time, the pooled live birth rate (52.57% vs 18.09% P =0.0399) of HR followed by progestogens are significantly higher than the LNG-IUS alone. Which no statistical difference in regression (98.06% vs 94.24%; P = 0.4098) and recurrence rates (4.79% vs 3.90% P = 0.8561) was seen.

Conclusions: Of the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.

Keywords: complex atypical hyperplasia; endometrial carcinoma; fertility-sparing therapy; hysteroscopic resection; oral progestogens.

Conflict of interest statement

CONFLICTS OF INTEREST The authors report no conflicts of interest.

Figures

Figure 1. Study selection process
Figure 1. Study selection process
Figure 2. Quality assessment of the studies
Figure 2. Quality assessment of the studies
Figure 3. Regression rate between hysterscopic resection…
Figure 3. Regression rate between hysterscopic resection (HR) and oral progestogens (P)
Figure 4. Live birth rate between hysterscopic…
Figure 4. Live birth rate between hysterscopic resection (HR) and oral progestogens (P)
Figure 5. Recurrence rate between hysterscopic resection…
Figure 5. Recurrence rate between hysterscopic resection (HR) and oral progestogens (P)

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